To summarize the evidence on gender-specific differences in disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) after radical cystectomy for bladder cancer.
A systematic literature search of the MEDLINE, EMBASE, and Cochrane libraries was conducted in July 2017. Studies evaluating gender-specific differences in DFS, CSS, or OS after radical cystectomy for bladder cancer were included. Analyses included random effect meta-analysis, subgroup analyses, meta-influence, and cumulative meta-analyses. Funnel plot and Egger´s test were used to assess publication bias.
Of 3,868 studies identified during literature search, 59 studies published between 1998 and 2017 were included: 30 studies (38,321 patients) evaluated DFS, 44 studies (69,666 patients) evaluated CSS, and 26 studies (30,039 patients) evaluated OS. Random effect meta-analyses showed decreased DFS, CSS, and OS for female patients compared to their male counterparts. Pooled estimates were for DFS hazard ratio (HR)=1.16 (95% confidence interval (95% CI): 1.06-1.27, p=0.0018), for CSS HR=1.23 (95% CI: 1.15-1.31, p<0.001), and for OS HR=1.08 (95% CI: 1.03-1.12, p=0.0004). Subgroup analyses confirmed impaired DFS, CSS, and OS for female patients in all strata. Publication bias was evident only for studies evaluating CSS (Egger´s test p=0.0029). After adjustment for publication bias via the trim and fill method, the corrected pooled estimate for CSS was HR=1.13 (95% CI: 1.05-1.21, p=0.0012).
Female patients undergoing radical cystectomy for bladder cancer demonstrate worse DFS, CSS, and OS compared to their male counterparts. The multifactorial etiology might include epidemiological differences, gender-specific health-care discrepancies, and hormonal influences.
The Journal of urology. 2018 Mar 01 [Epub ahead of print]
Annemarie Uhlig, Ali Seif Amir Hosseini, Jörg Simon, Joachim Lotz, Lutz Trojan, Marianne Schmid, Johannes Uhlig
Department of Urology, University Medical Center Goettingen, Goettingen, Germany. Electronic address: ., Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany., Department of Urology and Pediatric Urology, Ortenau Hospital, Offenburg, Germany., Department of Urology, University Medical Center Goettingen, Goettingen, Germany., Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, United States of America.